Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-1406

2. Registrant Information.

Registrant Reference Number: 160020271

Registrant Name (Full Legal Name no abbreviations): Farnam Companies, Inc.

Address: 301 W. Osborn Road

City: Phoenix

Prov / State: Arizona

Country: USA

Postal Code: 85013

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

12-FEB-16

5. Location of incident.

Country: UNITED STATES

Prov / State: ARKANSAS

6. Date incident was first observed.

06-FEB-16

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 67517-66-270

Product Name: Just One Bite EX Bait Block 0.5 Oz

• Active Ingredient(s)
  • BROMETHALIN
    • Guarantee/concentration .01 %

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Doberman Pinscher

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

9.0

7. Weight (provide a range if necessary )

93.0

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

On February 6, 2016 the dog developed lethargy and anorexia. On February 7, 2016 the dog died. On February 12, 2016 the owner contacted the Animal Product Safety Service (APSS) and stated she was not sure where the dog got the bait, but she did see evidence of the bait in his stool. The APSS veterinarian stated bromethalin is a neurotoxin and in low doses of 0.1-0.4 milligrams per kilogram (mg/kg) may expect a "paralytic syndrome" with signs of transient weakness and lethargy. The APSS veterinarian also stated in higher doses the agent may cause nerve fiber swelling or a "convulsant syndrome" with signs of muscle tremors and seizures (leading to cerebral edema). The APSS veterinarian tried to go over the case with the owner, but was unsuccessful as the owner is convinced that the agent caused the death of her dog, due to her veterinarian (who identified the agent and stated it caused brain swelling). The APSS veterinarian recommended calling back with questions. A necropsy was not available.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

The APSS veterinarian stated that the substance was considered to have a low likelihood of causing the clinical situation. A follow up was not performed, because additional information was not expected.